The role of splenectomy in the management of advanced hodgkin's disease

Abstract

Thirty-five patients suffering from Hodgkin's disease developed severe and persistent depression of one or all three of the peripheral blood elements, red blood cells, white blood cells, or platelets. This appeared quite commonly unrelated to any treatment, and in the absence of clinically demonstrable splenomegaly. In the majority of the patients included in this series, evidence was obtained using standard radioisotopic procedures of increased cell destruction, of either red cells or platelets with a significant number also demonstrating disorder of iron kinetics. After splenectomy, involvement of the spleen by Hodgkin's disease was demonstrated in 23 patients. In 12 cases the spleen was not involved, but in 7 of these evidence of increased red cell destruction was shown by iron accummulation, or destruction of platelets by myelin figures. Complete correction of peripheral blood parameters resulted in 28 with a subsequent median complete remission of 24 months, and improved tolerance to therapy. The incidence of postoperative infection was unremarkable. It is concluded that improved tolerance to therapy can be achieved by splenectomy in patients with far advanced Hodgkin's disease even in the absence of splenic involvement.